Provider Demographics
NPI:1457562647
Name:LINDROOTH, CHARIS (DC)
Entity Type:Individual
Prefix:
First Name:CHARIS
Middle Name:
Last Name:LINDROOTH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15525 KUTZTOWN RD
Mailing Address - Street 2:
Mailing Address - City:KUTZTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19530-9303
Mailing Address - Country:US
Mailing Address - Phone:610-683-9363
Mailing Address - Fax:610-683-5431
Practice Address - Street 1:15525 KUTZTOWN RD
Practice Address - Street 2:
Practice Address - City:KUTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19530-9303
Practice Address - Country:US
Practice Address - Phone:610-683-9363
Practice Address - Fax:610-683-5431
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC5718L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA532260OtherHIGHMARK BLUE SHIELD
PA0806015000OtherPERSONAL CHOICE
PA3145600OtherCAPITAL BC
PA779354Medicare ID - Type Unspecified
PA0806015000OtherPERSONAL CHOICE